Provider Demographics
NPI:1831531334
Name:MAXWELL, LINDA L (NP-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1724
Mailing Address - Country:US
Mailing Address - Phone:203-470-3755
Mailing Address - Fax:
Practice Address - Street 1:300 BOSTON POST RD
Practice Address - Street 2:UNIVERSITY OF NEW HAVEN
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1916
Practice Address - Country:US
Practice Address - Phone:203-932-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily